Helping patients access and adhere to antipsychotic medicationsTexas Children's Health Plan
A common reason for behavioral health readmission is delay to an outpatient supply of antipsychotic medications. You can help avoid this problem by completing prior authorization documentation before a patient is discharged. Texas Children’s Health Plan follows Texas Medicaid Guidelines for the use and approval of antipsychotics in children.
Prior authorization documentation for antipsychotic medications can be found here: https://www.navitus.com/Misc-Pages/PDF-Form-Viewer.aspx?FormID=5264d812-b3d9-45f7-9b7a-a48eefca8adc
Providers can ensure patients receive antipsychotic medications at discharge by using the hospital pharmacy or a community pharmacy delivery service. If a patient does not meet criteria, a medical director at Texas Children’s Health Plan can review submitted appeal requests to approve based on medical necessity.
Please contact your Provider Relations representative at 832-828-1008 if you need guidance on the prior authorization and appeal process, or for more information on participating retail pharmacies who can deliver your patient’s medications prior to discharge.
Texas Children’s Health Plan Case Management staff is also a resource available to work with you and your patients to help remove barriers that may be impacting care. You can reach Case Management at 832-828-1430.